Bariatric Surgery ::: All you need to know – Bariatric surgery


Bariatric surgery, we think we know every thing we need to know about it, but do we really? Apart from the fact that a baraitric surgery is a weight-loss surgery for obese individuals, what do we really know about this procedure? When is Bariatric surgery performed? Is it safe? What are the kinds of procedures that can be adopted? How effective is the surgery? Are there any side effects? Not a lot of people have the answer to these questions. Not a lot a people have probably thought of these questions, so hopefully a glance through this section can clear some of the common doubts and misconceptions.

When is a Bariatric surgery recommended?

Medical guidelines suggest that the procedure can be an option in patients with a BMI of 40 or more, especially if these patients are diabetic or hypertensive and diet and exercise don’t seem to help. The surgical team will run a diagnosis to evaluate the patient before recommending surgery.

What are the procedures involved in Bariatric surgery?

Bariatric surgeries are generally of three types. A surgery can be either malabsorptive, restrictive or a combination of both.

Malabsorptive procedures: Effectively reduce the stomach size but mainly work through malabsorption (a condition that occurs because of abnormal absorption of nutrients in the Gastrointestinal tract also known as GI tract).

  • Bilopancreatic diversion: Rarely performed nowadays because of the post0op problems involved, and is replaced by a procedure known as duodenal switch. A smaller stomach is created by resecting a part of it, however, the patient does not have any diet restrictions because of the procedure. Some surgeons prefer removing the gall bladder also, as a preventive measure to avoid complications such as gall stones, whereas other surgeons opt to prescribe medications.
  • Jejunoiloeal Bypass: Not performed at all today because of thye complications and problems involved.
  • Endoluminal sleeve: A technique still in its trial stages involves placing an impermeable sleeve into the intestine to block absorption in the duodenum and jejunum.

Restrictive procedures: These are procedures the reduce oral intake by reducing the gastric volume. These procedures have reduced risk of metabolic complications.

  • Vertical banded gastroplasty: Also known as stomach stapling, a part of the stomach is permanently stapled in this procedure to create a smaller pre-stomach pouch. A small hole at the bottom of this pouch lets the food flow into the remainder of the stomach and the GI tract. This pouch reduces the amount of food an individual can eat at a single point of time.
  • Adjustable gastric band: Another technique of restricting the stomach. A silicon band is used which can be adjusted by adding or removing saline. The procedure is also known as lap band can also be performed through the Minimally Invasive Surgery (MIS) technique.
  • Sleeve gastrectomy: Also known as gastric sleeve where a large portion of the stomach following the major curve is surgically removed and the stomach is reduced to 15% of its actual size. Needless to say, the size of the stomach is permanently reduced in this procedure, which is also performed using the MIS technique. The stomach still tends to function normally and most food items can be consumed in small amounts.
  • Intragastric balloon: A procedure which is yet to be approved by the FDA, but is approved in many countries including India, it involves placing a deflated balloon in the stomach and then filling it, so it reduces the space in the stomach. The balloon can however, be placed inside the stomach for a maximum of six months.
  • Gastric Plication: In this procedure the stomach is sutured which significantly reduces it’s volume. The outcome is quite similar to what is obtained in Sleeve Gastrectomy. The only difference is that the stomach is sutured instead of being removed.

Mixed Procedures: Procedures where both, malabsorptive and restrictive techniques are applied simultaneously.

  • Gastric Bypass Surgery: A small pouch is created with a stapler device and connected to the distall part of the small intestine. This is one of the most common procedures in the united States of America
  • Sleeve Gastrectomy with duodenal switch: A part of the stomach along its greater curve is resected and the stomach is “tubulized” with a residual volume of about 150 ml. This volume restricts the food intake of the patient
  • Implantable gastric simulation: Another procedure which is still being studied in USA. The procedure employs a device, similar to a pacemaker, with electrical leads on the surface of the stomach.

How effective is a Bariatric Surgery?

Malabsorptive procedures have been found to have higher weight-loss effects as compared to Restrictive procedures; however they also involve higher risk factors.

Several studies reveal a decrease in the mortality rates after bariatric surgery.

Do Bariatric Surgeries have ill effects?

Rapid weight loos after surgery can contribute to development of gall stones. Nutritional deficiencies of micronutrients like iron and some vitamins are observed, especially after a malabsorptive procedure.

Metabollic bone disease and secondary hyperparathyroidism have also been observed in some studies.

All these points make it clear that it is important to consult a well qualified and experienced surgeon before opting for a Bariatric surgery, as is the case with other surgeries as well.

Asian Heart Institute has launched the Asian Minimally Invasive Surgery Institute which will cater to the needs of the patients who require a Bariatric Surgery. You can call +91-22-6698 6538/39 to consult with our world-class doctors, and the weighing scale will soon cease to be a nightmare.

For more information on diet, health and nutrition, please email Harpinder Gill at harpinder.gill@ahirc.com. You are welcome to email us with any question on any health topic. Please allow 24 hours for an answer, and if your query seems requiring an urgent response, expect to hear from us before that time.

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